Objective Sleep Disturbance After Total Hip and Knee Arthroplasty: A Systematic Review of Wearable-Derived Metrics...

Sleep disturbance is common in patients with hip and knee osteoarthritis and may worsen during the perioperative period of total joint arthroplasty. Poor sleep has been linked to higher pain, delayed functional recovery, and reduced patient satisfaction; however, most arthroplasty studies rely on subjective questionnaires, providing limited insight into the magnitude and time course of postoperative sleep disruption.

A systematic literature search of PubMed, Embase, and the Cochrane Library was conducted from inception to November 17, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting objective perioperative sleep assessment using actigraphy, consumer wearables, or portable electroencephalography (EEG) in adults undergoing total hip arthroplasty or total knee arthroplasty were included.

Seven studies met inclusion criteria, including observational cohorts and randomized controlled trials. Objective monitoring consistently demonstrated substantial sleep disruption in the early postoperative period, characterized by reduced nocturnal sleep duration, increased fragmentation, and decreased sleep efficiency, with gradual recovery over subsequent days to weeks. Studies using portable EEG identified marked but transient suppression of rapid eye movement (REM) sleep immediately after surgery. Longer-term wearable monitoring suggested stabilization of total sleep time, although correlations with subjective sleep quality were variable. Pharmacologic interventions showed minimal or inconsistent benefits on objective sleep duration or architecture.

Objective wearable monitoring identifies reproducible sleep disruption after total hip arthroplasty and total knee arthroplasty that is incompletely captured by patient-reported measures. Standardized objective endpoints, validation of wearable devices in arthroplasty populations, and integration of sleep assessment into enhanced recovery pathways may improve postoperative care and patient-centered outcomes.